Key Points

• Patients who have ever smoked should be evaluated by spirometry before undergoing thoracic surgical procedures.
• For patients with moderate to severe airflow obstruction, a rehabilitation regimen of smoking cessation, graded exercise, supplemental oxygen if required, and appropriate medical therapy may improve perioperative mortality.
• An intensive regimen of short-acting bronchodilators,controlled oxygen therapy, airway care, and monitoring of arterial blood gases in the postoperative period may avert the need for mechanical ventilation.
• Noninvasive ventilation in the postoperative period for patients with hypercarbic respiratory failure may avert the need for endotracheal intubation and mechanical ventilation.

Many of the diseases treated by thoracic surgeons are associated with long-term use of cigarettes. From aortic aneurysms to esophageal cancer, cigarette smoke inhalation is a common factor. Therefore, it is not surprising that many of the patients seen by thoracic surgeons have chronic obstructive pulmonary disease (COPD).

COPD is a preventable and treatable disease state characterized by expiratory airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases primarily caused by cigarette smoking.